Ocular Surface Disorders In Intensive Care Unit Patients In A Sub-Saharan Teaching Hospital

Ibironke Desalu; Folasade Akinsola; Oyebola Adekola; Omobolade Akinbami; Olusola Kushimo; Adebukunola Adefule-Ositelu

摘要

Purpose: We investigated the incidence of ocular surface disorders and determined predisposing factors in order to establish guidelines for eye care in intensive care unit patients in a Nigerian teaching hospital. Methods: All unconscious and critically ill patients were investigated. Data included duration of sedation, muscle relaxants and mechanical ventilation and presence of organ failure. The eyes were examined daily and the eyelid position noted. Results : Fifty-six patients were studied. 31 patients (55.4%.) developed OSD. The duration of sedation (4.06 vs 1.80 days) and ventilation (4.55 vs 1.62 days) as well as severity of illness significantly influenced the development of OSD, but the position of the eyelids did not. Patients who received saline irrigation were more likely to develop OSD (p=0.02). Conclusion: ICU patients in our institution frequently develop OSD. There is a need to develop strict eye care guidelines for especially in the setting of organ failure. Introduction Ocular surface disorders (OSD) characterized by disorders of the conjunctiva or cornea have been described in the anaesthetized patients.1 It also occurs in patients with compromised protective eye mechanism like the unconscious, sedated or paralysed patients.2 Though OSD are usually self-limiting, they may lead to visual impairment or blindness if extensive. Post-recovery visual loss would be devastating to any patient who has recovered from the physical and psychological impact of intensive care therapy.In the critically ill and unconscious patients, predisposing factors include position of the lid, use of mechanical ventilation, presence of respiratory tract infection or organ failure and prophylactic eye care instituted. Temperature and humidity also play an important role in patients with incomplete eye closure. Nigeria is a tropical country with daily temperatures reaching 32 – 40°C and humidity of 65 – 87%.3 In our institution, there is no definite protocol for eye care in the unconscious patient. The object of this study therefore was to determine the incidence of ocular surface disorders in our critically ill patients and determine predisposing factors with the aim of establishing strict guidelines for the eye care in these patients. Patient and Methods A prospective study of all unconscious patients admitted into our intensive care unit(ICU) over a four month period, from June 2007 to September 2007 was done. Data included age and gender as well as indication for admission. ICU management strategies were documented. These included the use of sedation and muscle relaxants, duration of ventilation, sedation and muscle relaxation. The eyelid position of the patients was noted and documented as either complete eye closure or incomplete eye closure when part of the conjunctiva or cornea was visible. The eyes were examined daily with pen torch light and ophthalmoscope for presence of conjunctival or corneal disorders. A binocular loupe of x 4 magnification was used where applicable as there was no hand-held slit-lamp. Conjunctiva disorder was defined as the presence of injection, oedema or exudates of the conjunctiva. Corneal disorder was diagnosed when haziness, dryness or ulceration was apparent with a positive fluorescein staining. Eye care treatment instituted if any was documented.The room temperature and humidity of the ICU was recorded daily by reading of a room thermometer and a wet and dry hygrometer respectively.Organ failure was determined using preset criteria; organic brain damage, hypotension (systolic blood pressure t-test, chi-square or Fisher's exact test as indicated using SPSS? version 10.1. Numerical data was expressed as mean ± SD while categorical data was expressed as frequencies. A p value < 0.05 was considered statistically significant. Results Fifty-six patients were recruited into the study. The mean age of the patients was 36.55 ± 16.68 years with a range of 5 to 78 years and a male: female ratio of 3 : 1. Table

机译：目的：我们调查了眼表疾病的发生率并确定了诱发因素，以便为尼日利亚一家教学医院的重症监护病房患者的眼部护理制定指南。方法：对所有昏迷和重症患者进行调查。数据包括镇静时间，肌肉松弛剂和机械通气以及器官衰竭的存在。每天检查眼睛并记录眼睑位置。结果：对56例患者进行了研究。 31例（55.4％。）患OSD。镇静时间（4.06 vs 1.80天）和通气时间（4.55 vs 1.62天）以及疾病的严重程度显着影响了OSD的发展，但眼睑的位置却没有。接受盐水冲洗的患者更有可能发生OSD（p = 0.02）。结论：我们机构的ICU患者经常发生OSD。需要制定严格的眼保健指导，尤其是在器官衰竭的情况下。简介麻醉患者中已描述了以结膜或角膜疾病为特征的眼表疾病（OSD）。1它也发生在保护性眼部功能受损的患者中，例如无意识，镇静或瘫痪的患者。2尽管OSD通常是自发性的限制，如果广泛，它们可能导致视力障碍或失明。恢复后的视力丧失对于任何从重症监护治疗后的生理和心理影响中恢复过来的患者而言都是灾难性的。在重症和昏迷患者中，诱发因素包括眼睑位置，使用机械通气，呼吸道的存在感染或器官衰竭，并进行预防性眼保健。温度和湿度在闭眼不完全的患者中也起着重要作用。尼日利亚是一个热带国家，日温度达到32 – 40°C，湿度为65 – 87％。3在我们的机构中，尚无明确的协议来保护失去知觉的患者。因此，本研究的目的是确定重症患者眼表疾病的发生率，并确定诱发因素，以期为这些患者的眼保健建立严格的指导方针。患者和方法对2007年6月至2007年9月这四个月期间收治于我们重症监护室（ICU）的所有无意识患者进行了前瞻性研究。数据包括年龄和性别，以及入院指示。记录了ICU管理策略。这些措施包括镇静剂和肌肉松弛剂的使用，通气时间，镇静剂和肌肉松弛。记录并记录患者的眼睑位置，即可见部分结膜或角膜时完全闭眼或不完全闭眼。每天用手电筒灯和检眼镜检查眼睛是否有结膜或角膜疾病。由于没有手持裂隙灯，因此在适用的情况下使用双倍放大镜，放大倍数为4。结膜疾病定义为存在结膜注射液，水肿或渗出液。荧光素染色阳性时，如果出现浑浊，干燥或溃疡，则可诊断为角膜疾病。如果有的话，采取眼保健治疗措施。每天分别通过读取室内温度计和干湿湿度计记录ICU的室内温度和湿度。器质性脑损伤，低血压（收缩压t检验，卡方检验或Fisher精确检验，使用SPSS？版本10.1表示。数字数据表示为平均值±SD，分类数据表示为频率。p值<0.05为结果共纳入56名患者，平均年龄为36.55±16.68岁，年龄范围为5至78岁，男女之比为3：1。

Ocular Surface Disorders In Intensive Care Unit Patients In A Sub-Saharan Teaching Hospital

摘要

著录项

相似文献

相关主题

期刊订阅